Monday, December 14, 2009

EDITORIAL >> Senators aid reform effort

Not long ago, we lamented that unlike the creation of Social Security, Medicare and Medicaid, the great social advancements of the 20th Century, Arkansas’ Washington delegates were not playing a helpful role in spreading health protection to nearly all the American people. The two congressmen representing our parts and the environs east of us voted for a progressive health-insurance bill, but the other six delegates took a powder or else seemed to be working against reform. They capitulated to the fears stirred by the insurance companies and the fanatical wing of the Republican Party.

This week, we can be more sanguine. Sen. Mark Pryor and, yes, Sen. Blanche Lincoln were in harness with their party and actually played a pivotal role in fashioning what is likely to be the compromise that makes health-insurance reform a reality. They were part of the Gang of Ten, the senators who were assigned to work things outs, and Pryor especially was credited with yoking the moderates and liberals to a plan that would break the stalemate. His old man must be proud. David Pryor sometimes played that part to perfection for two decades.

Pryor and Lincoln still do not compare to the giants of the past. Senator Joe T. Robinson of Lonoke, the leader of the Senate, powered Social Security to enactment in 1935. Rep. Wilbur D. Mills, who hailed from Kensett about 35 miles to our north on Highway 67, wrote the final Medicare-Medicaid bill in 1965 and shepherded it through the House of Representatives. In both 1935 and 1965, all the rest of the Arkansas delegation voted for the bills.

Sure, it was easier in those days. Republicans fought Social Security and Medicare, too, but they were not so bent on seeing a Democratic president fail that they would use the Senate’s unlimited-speech rule to prevent majority rule.

The precise lineaments of the compromise have not been revealed while the Congressional Budget Office calculates a price tag. All we know is that in lieu of the controversial “public option” — a set of voluntary government-sponsored insurance plans that would compete with private insurance companies for the business of individuals who do not have insurance — the uninsured would be offered an array of privately run but government-supervised insurance plans similar to those available now to federal employees, including members of Congress.

The uninsured from 55 to 64 years old could buy a policy from an insurance company with some government help if their incomes were low enough (and the insurance companies could not refuse them coverage), or else they could buy into the Medicare system. The government would not pay for their care like it does for those 65 and older, and the Medicare premiums might be so high that most of the currently uninsured could not afford it. It basically would be a plan for the chronically sick who have been cut off by the insurance companies — the people who need help the most. For the government to break even, as the proposal apparently requires, the premiums may have to be steep.

Far better would be a public option that could use its market power to drive down medical costs and force monopoly insurance companies to offer competitive premiums to employers and individuals. But that appeared undoable because Sen. Lincoln, a couple of other Democrats and the independent Joe Lieberman said they would join the Republicans and prevent a vote on a bill that included competition for the insurance industry.

Without a public option, little in either the Senate or House health bills would work to stop the spiral of health costs, which makes the U. S. health-care system the most expensive and least productive in the industrialized world. Both bills include a number of pilot projects that might someday show the way out of the predicament in the same way that pilot farm programs a century ago eventually led the nation out of the farm and food crisis. But the Medicare buy-in for the pre-elderly and the smorgasbord of government-sanctioned but privately administered medical policies that Pryor and Lincoln helped fashion are modestly better than carte blanche to the insurance industry. They do afford a small measure of market competition, and that is good.

If they produce a comprehensive health bill, albeit one with very modest goals, our senators will deserve a medium-sized footnote in the history books. For our times that will have to be good enough.